Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 54
Filtrar
Añadir filtros

Base de datos
Intervalo de año
1.
J Clin Endocrinol Metab ; 105(8)2020 08 01.
Artículo en Inglés | MEDLINE | ID: covidwho-621873

RESUMEN

CONTEXT: The potential for endocrine care via telemedicine has been recognized since the early 2000s when clinical outcome data demonstrated improvements in glycemic control with telemedicine. The widespread use of telemedicine during the COVID-19 pandemic has pushed telemedicine beyond diabetes care and into clinical areas with a paucity of published data. The evaluation and treatment of thyrotoxicosis heavily relies on laboratory assessment and imaging with physical exam playing a role to help differentiate the etiology and assess the severity of thyrotoxicosis. CASE DESCRIPTION: We describe a patient presenting for evaluation of new thyrotoxicosis via telemedicine, and describe modifications to consider for thorough, safe evaluation via telemedicine. CONCLUSION: Telemedicine may be an ideal way to assess and treat patients with thyrotoxicosis who are not able to physically attend a visit with an endocrinologist but still have access to a laboratory for blood draws. Potential challenges include access to imaging and high-volume surgeons if needed. Clinical and economic outcomes of telemedicine care of thyrotoxicosis should be studied so that standards of care for endocrine telemedicine can be established.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Endocrinología/métodos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Evaluación de Síntomas/métodos , Telemedicina/métodos , Tirotoxicosis/diagnóstico , Adulto , Betacoronavirus , Femenino , Humanos
3.
J Bras Nefrol ; 42(2 suppl 1): 44-46, 2020 Aug 26.
Artículo en Inglés, Portugués | MEDLINE | ID: covidwho-740466

RESUMEN

INTRODUCTION: Palliative care is an approach aimed at relieving suffering, controlling symptoms and seeking to improve quality of life. It must be offered in conjunction with standard treatment for any disease that threatens the continuation of life, such as a Covid-19 infection. DISCUSSION: The bioethical principles and strategies used by palliative medicine can assist nephrologists in the care of patients with renal dysfunction, who face the difficulties of isolation at the beginning and follow-up of dialysis in outpatient treatment, and those who are at risk for a more serious disease progress. Some of them: - a Shared decision making, which enables the patient and family to participate as facilitators in the systematization of the team's reasoning, in addition to respecting the principle of autonomy; - Symptom Management: which should be a priority to ensure relief of suffering even in times of social isolation; - Communication skills: making it possible to alleviate suffering in announcing bad news or complex decisions through communication techniques;; - Bereavement assistance: which in acute situations such as the pandemic, causing unexpected losses, the importance of sympathy from healthcare professionals becomes even greater. CONCLUSION: The principles of palliative care are essential to face the challenges of a planet-wide crisis, which raises human suffering in all dimensions, and which requires the construction of strategies that can keep patients assisted, comfortable and with measures proportional to their clinical condition and preferences.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Cuidados Paliativos/métodos , Neumonía Viral/epidemiología , Terapia de Reemplazo Renal/normas , Aflicción , Comunicación , Toma de Decisiones Conjunta , Humanos , Nefrología/normas , Pandemias , Terapia de Reemplazo Renal/métodos , Evaluación de Síntomas/métodos
4.
Medicine (Baltimore) ; 99(35): e21810, 2020 Aug 28.
Artículo en Inglés | MEDLINE | ID: covidwho-740205

RESUMEN

RATIONALE: The clinical manifestations of the SARS-CoV-2 infection are mainly respiratory but the virus can cause a variety of symptoms. Dermatological findings are less well-characterized. Data is scarce on their timing, type and correlation with the immune response. PATIENT CONCERNS: We present the case of SARS-CoV-2 infection in a previously healthy woman who presented with respiratory symptoms and developed anosmia, diarrhea, and an erythematous maculo-papular rash on day 15 from symptom onset. DIAGNOSIS: The nasopharyngeal swab tested by real time PCR for COVID-19 was positive. We interpreted this as a viral exanthema likely caused by an immune response to SARS-CoV-2 nucleotides. INTERVENTIONS: She was treated with Hydroxychloroquine, Azithromycin and Lopinavir/Ritonavir, and the rash with topical corticosteroids. OUTCOMES: All symptoms resolved except for anosmia which persisted for 6 weeks. At the 4- and 6-weeks follow-up the IgG titers for SARS-CoV-2 were high. LESSONS: We must consider that SARS-CoV-2 has a multi-organ tropism. In our case, the SARS-CoV-2 infection had lung, nasopharyngeal, neurological, digestive, and skin manifestations. Identifying the different manifestations is useful for understanding the extent of SARS-CoV-2 infection. We not only present a rare manifestation but also suggest that cutaneous manifestations may correlate with immunity.


Asunto(s)
Azitromicina/administración & dosificación , Betacoronavirus , Infecciones por Coronavirus , Exantema , Glucocorticoides/administración & dosificación , Hidroxicloroquina/administración & dosificación , Lopinavir/administración & dosificación , Pandemias , Neumonía Viral , Ritonavir/administración & dosificación , Administración Tópica , Adulto , Antivirales/administración & dosificación , Betacoronavirus/inmunología , Betacoronavirus/aislamiento & purificación , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Combinación de Medicamentos , Exantema/diagnóstico , Exantema/tratamiento farmacológico , Exantema/etiología , Exantema/inmunología , Femenino , Humanos , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Evaluación de Síntomas/métodos , Resultado del Tratamiento
5.
Medicine (Baltimore) ; 99(33): e21618, 2020 Aug 14.
Artículo en Inglés | MEDLINE | ID: covidwho-740197

RESUMEN

BACKGROUND: Coronavirus disease 2019, (COVID-19) is a major problem in public health in the world. Up to June, 2020, the number of infections arising to 8,690,000 and cause 410,000 deaths all over the world. Identification the clinical symptoms from non-severe to severe is important for clinician. This meta-analysis aimed to compare the clinical symptoms between severe and non-severe COVID-19 pneumonia. METHODS: Electronic databases including PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure database, Wanfang Database and Chinese Biomedical Literature Database were searched from its inception to June 21, 2020. We only included severe versus non-severe COVID-19 pneumonia patients and pooled results were summarized by STATA 12.0 software.Two researchers independently selected the study and assessed the quality of the included studies. The heterogeneity was measured by I tests (I < 50 indicates little heterogeneity, I≥50 indicates high heterogeneity). Publication bias was ruled out by funnel plot and statistically assessed by Begg test (P > .05 as no publication bias). RESULTS: Results will be published in relevant peer-reviewed journals. CONCLUSION: Our study aims to systematically present the clinical symptoms between non-severe and severe of COVID-19 patients, which will be provide clinical guidance for COVID-19 patients.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Índice de Severidad de la Enfermedad , Evaluación de Síntomas/métodos , Estudios de Cohortes , Femenino , Humanos , Masculino , Metaanálisis como Asunto , Pandemias , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación , Revisiones Sistemáticas como Asunto
7.
Medwave ; 20(6): e7950, 2020 Jul 02.
Artículo en Español, Inglés | MEDLINE | ID: covidwho-696250

RESUMEN

The purpose of this article is to review the characteristics of SARS-CoV-2, the clinical-epidemiological aspects of COVID-19, and the implications anesthesiologists when performing aerosol-generating procedures. A search of PubMed/MEDLINE, Scopus, SciELO, and Web of Science databases was performed until April 9, 2020, using the words: "COVID-19 or COVID19 or SARS-CoV-2 and anesthesiology or anesthesia". Forty-eight articles with information on the management of the patient in the perioperative period or the intensive care unit when suspected or confirmed SARS-CoV-2 infection were included. In general, the postponement of elective surgeries for no more than 6 to 8 weeks, depending on the clinical condition of the patients is recommended. In the case of urgent or emergency surgeries, we review the use of personal protection gear, as well as the recommended strategies for carrying out the procedure.


Asunto(s)
Anestesiología/normas , Betacoronavirus , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Enfermedades Profesionales/prevención & control , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Aerosoles , Anestesia de Conducción/métodos , Anestesia Epidural/métodos , Anestesia General/métodos , Anestesia Raquidea/métodos , Anestesiología/organización & administración , Betacoronavirus/genética , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/transmisión , Procedimientos Quirúrgicos Electivos , Humanos , Unidades de Cuidados Intensivos , Intubación Intratraqueal/métodos , Intubación Intratraqueal/normas , Bloqueo Nervioso/métodos , Pandemias , Equipo de Protección Personal , Neumonía Viral/diagnóstico , Neumonía Viral/transmisión , Respiración Artificial/métodos , Respiración Artificial/normas , Procedimientos Quirúrgicos Operativos , Evaluación de Síntomas/métodos
8.
MMWR Morb Mortal Wkly Rep ; 69(31): 1026-1030, 2020 Aug 07.
Artículo en Inglés | MEDLINE | ID: covidwho-694883

RESUMEN

SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), is spread from person to person (1-3). Quarantine of exposed persons (contacts) for 14 days following their exposure reduces transmission (4-7). Contact tracing provides an opportunity to identify contacts, inform them of quarantine recommendations, and monitor their symptoms to promptly identify secondary COVID-19 cases (7,8). On March 12, 2020, Maine Center for Disease Control and Prevention (Maine CDC) identified the first case of COVID-19 in the state. Because of resource constraints, including staffing, Maine CDC could not consistently monitor contacts, and automated technological solutions for monitoring contacts were explored. On May 14, 2020, Maine CDC began enrolling contacts of patients with reported COVID-19 into Sara Alert (MITRE Corporation, 2020),* an automated, web-based, symptom monitoring tool. After initial communication with Maine CDC staff members, enrolled contacts automatically received daily symptom questionnaires via their choice of e-mailed weblink, text message, texted weblink, or telephone call until completion of their quarantine. Epidemiologic investigations were conducted for enrollees who reported symptoms or received a positive SARS-CoV-2 test result. During May 14-June 26, Maine CDC enrolled 1,622 contacts of 614 COVID-19 patients; 190 (11.7%) eventually developed COVID-19, highlighting the importance of identifying, quarantining, and monitoring contacts of COVID-19 patients to limit spread. In Maine, symptom monitoring was not feasible without the use of an automated symptom monitoring tool. Using a tool that permitted enrollees to specify a method of symptom monitoring was well received, because the majority of persons monitored (96.4%) agreed to report using this system.


Asunto(s)
Trazado de Contacto , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Monitoreo Epidemiológico , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Automatización , Niño , Preescolar , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Femenino , Humanos , Lactante , Recién Nacido , Maine/epidemiología , Masculino , Persona de Mediana Edad , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Evaluación de Programas y Proyectos de Salud , Evaluación de Síntomas/métodos , Adulto Joven
9.
Clin Transl Gastroenterol ; 11(7): e00215, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-681344

RESUMEN

INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing the pandemic of coronavirus disease 2019 (COVID-19) is a global health crisis. Possible pancreatic involvement has recently been observed in these patients; however, its significance is unclear. The aim of this study was to evaluate the association of significantly elevated lipase with disease outcomes. METHODS: Data about demographics, symptoms, laboratory values, and clinical outcomes were collected for 1,003 consecutive patients testing positive for COVID-19. Elevated lipase was defined as greater than 3 times the upper limit of normal (>3 × ULN). Baseline characteristics among patients with or without elevated lipase were compared using Fisher exact test or Student t-test for categorical or numerical variables, respectively. Logistic regression was used to evaluate the association of lipase levels with primary clinical outcomes (intensive care unit admission and intubation) adjusted for age, sex, body mass index, history of diabetes, and hypertension. RESULTS: Of 1,003 patients with COVID-19, 83 had available lipase levels and were all admitted to the hospital. Of 83, 14 (16.8%) had elevated lipase (>3 × ULN), which was associated with higher rates of leukocytosis (P < 0.001) and abnormal liver enzymes (P < 0.01). Compared with lower lipase levels (<3 × ULN), patients with elevated lipase had higher rates of ICU admission (92.9% vs 32.8%; P < 0.001) and intubation (78.6% vs 23.5%; P 0.002). In a multivariable-adjusted model, higher lipase levels were significantly associated with admission to the ICU and rate of intubation. DISCUSSION: Lipase elevation is seen in COVID-19 and is associated with worse disease outcomes.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus , Lipasa/sangre , Obesidad , Páncreas , Pandemias , Neumonía Viral , Anciano , Betacoronavirus/aislamiento & purificación , Betacoronavirus/fisiología , Índice de Masa Corporal , Estudios de Cohortes , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/diagnóstico , Obesidad/epidemiología , Páncreas/metabolismo , Páncreas/fisiopatología , Páncreas/virología , Neumonía Viral/sangre , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/fisiopatología , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Evaluación de Síntomas/métodos , Evaluación de Síntomas/estadística & datos numéricos , Estados Unidos/epidemiología
11.
Swiss Med Wkly ; 150: w20312, 2020 06 28.
Artículo en Inglés | MEDLINE | ID: covidwho-653052

RESUMEN

We present the case of an oncology patient admitted to our hospital during the current COVID-19 pandemic with clinical and radiological features strongly suggestive of interstitial pneumonia. Multiple laboratory tests were negative for SARS-CoV-2 (polymerase chain reaction testing of nasopharyngeal swabs, and of induced sputum and stool samples, investigation of serum immunoglobulins G and M). In the setting of an immunocompromised status due to recent chemotherapy cycles for lung adenocarcinoma and prolonged corticosteroid therapy (due to frequent exacerbations of chronic obstructive pulmonary disease in recent months), we actively searched for the pathological agent and found it to be Pneumocystis jirovecii. The patient started specific antibiotic treatment but finally had a negative outcome due to the progression of the lung adenocarcinoma. The importance of differential diagnostics in clinical practice should be a given, especially during times of pandemic. The novel coronavirus infection introduced new guidelines for and approaches to the investigation of immunocompromised patients, so it is especially important not to forget the basis of differential diagnosis, to and adopt a thorough approach when assessing these complex patients. We want to stress the importance of thorough investigation to avoid misdiagnosis of atypical pathogens in the current setting of SARS-CoV-2 pandemic.


Asunto(s)
Adenocarcinoma del Pulmón/complicaciones , Enfermedades Pulmonares Intersticiales/diagnóstico , Pulmón/diagnóstico por imagen , Pneumocystis carinii/aislamiento & purificación , Neumonía por Pneumocystis , Neumonía Viral/diagnóstico , Anciano , Betacoronavirus , Deterioro Clínico , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Diagnóstico Diferencial , Resultado Fatal , Femenino , Humanos , Pandemias , Neumonía por Pneumocystis/complicaciones , Neumonía por Pneumocystis/diagnóstico , Neumonía por Pneumocystis/fisiopatología , Neumonía por Pneumocystis/terapia , Neumonía Viral/complicaciones , Evaluación de Síntomas/métodos , Tomografía Computarizada por Rayos X/métodos
12.
Swiss Med Wkly ; 150: w20314, 2020 07 13.
Artículo en Inglés | MEDLINE | ID: covidwho-646809

RESUMEN

BACKGROUND: Since its first description in December 2019, coronavirus disease 19 (COVID-19) has spread worldwide. There is limited information about presenting characteristics and outcomes of Swiss patients requiring hospitalisation. Furthermore, outcomes 30 days after onset of symptoms and after hospital discharge have not been described. AIMS: To describe the clinical characteristics, outcomes 30 days after onset of symptoms and in-hospital mortality of a cohort of patients hospitalised for COVID-19 in a Swiss area. METHODS: In this retrospective cohort study, we included all inpatients hospitalised with microbiologically confirmed COVID-19 between 1 March and 12 April 2020 in the public hospital network of a Swiss area (Fribourg). Demographic data, comorbidities and outcomes were recorded. Rate of potential hospital-acquired infection, outcomes 30 days after onset of symptoms and in-hospital mortality are reported. RESULTS: One hundred ninety-six patients were included in the study. In our population, 119 (61%) were male and the median age was 70 years. Forty-nine patients (25%) were admitted to the intensive care unit (ICU). The rate of potential hospital-acquired infection was 7%. Overall, 30 days after onset of symptoms 117 patients (60%) had returned home, 23 patients (12%) were in a rehabilitation facility, 18 patients (9%) in a medical ward, 6 patients (3%) in ICU and 32 (16%) patients had died. Among patients who returned home within 30 days, 73 patients (63%) reported persistent symptoms. The overall in-hospital mortality was 17%. CONCLUSION: We report the first cohort of Swiss patients hospitalised with COVID-19. Thirty days after onset of the symptoms, 60% had returned home. Among them, 63% still presented symptoms. Studies with longer follow-up are needed to document long-term outcomes in patients hospitalised with COVID-19.


Asunto(s)
Cuidados Posteriores/estadística & datos numéricos , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus , Hospitalización/estadística & datos numéricos , Pandemias , Neumonía Viral , Anciano , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Demografía , Femenino , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Evaluación de Procesos y Resultados en Atención de Salud , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Estudios Retrospectivos , Suiza/epidemiología , Evaluación de Síntomas/métodos
13.
Medicine (Baltimore) ; 99(28): e21240, 2020 Jul 10.
Artículo en Inglés | MEDLINE | ID: covidwho-646231

RESUMEN

RATIONALE: Chest computed tomography (CT) scans play a key role in diagnosing and managing of COVID-19 pneumonia. The typical manifestations of COVID-19 pneumonia on a chest CT scan are ground glass opacities, consolidation, nodules, and linear opacities. It can be accompanied by a "crazy-paving" pattern, air bronchograms, pleural hypertrophy, and pleural effusion. However, no literature has reported a case with cavities in the lungs. PATIENT CONCERNS: A 34-year-old male patient complained of fever, cough, fatigue, myalgia, diarrhea, headache, and dizziness for 2 weeks. This patient is living in Xiaogan, a city around Wuhan, and he had contact with a patient with COVID-19 pneumonia from Wuhan <14 days before he had fever. DIAGNOSIS: A nucleic acid test by rRT-PCR returned positive on a pharyngeal swab, confirming the diagnosis of COVID-19 pneumonia. INTERVENTIONS: Isolation antiviral treatment. OUTCOMES: After 19 days of isolation and antiviral treatment, his temperature returned to normal and the symptoms were relieved. The laboratory results also were returning to normal levels. The chest CT scan showed that the acute inflammation had subsided significantly. With 2 consecutive novel coronavirus nucleic acid tests had returned negative, the patient was discharged from the hospital and sent to a government designated hotel for quarantine observation. The unique chest CT manifestation in this case was the small cavities in both lungs during the absorption phase of this disease. These small cavities developed into consolidated nodules with clear edges and gradually shrank or disappeared. LESSONS: Although 2 consecutive nucleic acid tests returned negative in this patient, the small cavity changes in the lungs were observed, so the patient was quarantined for 14 days. However, follow-up CT after the first 14 days' quarantine showed new small cavity changes on the lungs, a further 14 days of quarantine was recommended. Therefore, in some COVID-19 cases, even if the nucleic acid tests turns negative, the disappearance of lung lesions may take a long time. The repeated chest CT scan plays an important role in the diagnosis and evaluation of the recovery of COVID-19.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus , Pulmón/diagnóstico por imagen , Pandemias , Neumonía Viral/diagnóstico por imagen , Radiografía Torácica/métodos , Tomografía Computarizada por Rayos X/métodos , Adulto , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/cirugía , Infecciones por Coronavirus/terapia , Humanos , Masculino , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología , Neumonía Viral/cirugía , Neumonía Viral/terapia , Cuarentena/métodos , Recuperación de la Función , Evaluación de Síntomas/métodos , Resultado del Tratamiento
14.
Radiol Med ; 125(10): 926-930, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: covidwho-640752

RESUMEN

The Italian College of Breast Radiologists by the Italian Society of Medical Radiology (SIRM) provides recommendations for breast care provision and procedural prioritization during COVID-19 pandemic, being aware that medical decisions must be currently taken balancing patient's individual and community safety: (1) patients having a scheduled or to-be-scheduled appointment for in-depth diagnostic breast imaging or needle biopsy should confirm the appointment or obtain a new one; (2) patients who have suspicious symptoms of breast cancer (in particular: new onset palpable nodule; skin or nipple retraction; orange peel skin; unilateral secretion from the nipple) should request non-deferrable tests at radiology services; (3) asymptomatic women performing annual mammographic follow-up after breast cancer treatment should preferably schedule the appointment within 1 year and 3 months from the previous check, compatibly with the local organizational conditions; (4) asymptomatic women who have not responded to the invitation for screening mammography after the onset of the pandemic or have been informed of the suspension of the screening activity should schedule the check preferably within 3 months from the date of the not performed check, compatibly with local organizational conditions. The Italian College of Breast Radiologists by SIRM recommends precautions to protect both patients and healthcare workers (radiologists, radiographers, nurses, and reception staff) from infection or disease spread on the occasion of breast imaging procedures, particularly mammography, breast ultrasound, breast magnetic resonance imaging, and breast intervention procedures.


Asunto(s)
Citas y Horarios , Betacoronavirus , Neoplasias de la Mama/diagnóstico por imagen , Infecciones por Coronavirus/prevención & control , Pandemias/prevención & control , Neumonía Viral/prevención & control , Radiología , Sociedades Médicas , Cuidados Posteriores/organización & administración , Enfermedades Asintomáticas , Neoplasias de la Mama/psicología , Neoplasias de la Mama/terapia , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/psicología , Detección Precoz del Cáncer/normas , Femenino , Humanos , Italia , Enfermedades Profesionales/prevención & control , Equipo de Protección Personal , Neumonía Viral/epidemiología , Neumonía Viral/psicología , Evaluación de Síntomas/métodos , Evaluación de Síntomas/normas
16.
Nefrologia ; 40(4): 453-460, 2020.
Artículo en Inglés, Español | MEDLINE | ID: covidwho-634680

RESUMEN

The experience of a tertiary hospital and four hemodialysis centers attached to it during the COVID-19 epidemic is described. The organization of care that has been carried out and the clinical course of the 16cases of COVID-19 in hemodialysis patients are summarized. The joint application of measures, including patient screening, the early investigation of possible cases, the isolation of confirmed, investigational or contact cases, as well as the use of individual protection measures, has enabled the epidemic to be controlled. The clinical course of these 16patients is compared with the series published by the Wuhan University Hospital and with the data from the COVID-19 infection registry of the Spanish Society of Nephrology. In our experience, and unlike what was reported by the Wuhan Center, COVID-19 disease in hemodialysis patients is severe in a significant percentage of cases, and high lethality is mostly caused by the infection itself. Measures to contain the epidemic are effective.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Diálisis Renal , Centros de Atención Terciaria/organización & administración , Adulto , Anciano , Anciano de 80 o más Años , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/prevención & control , Femenino , Personal de Salud/estadística & datos numéricos , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Nefrología/organización & administración , Pandemias/prevención & control , Aislamiento de Pacientes/organización & administración , Neumonía Viral/epidemiología , Neumonía Viral/mortalidad , Neumonía Viral/prevención & control , Diálisis Renal/estadística & datos numéricos , España/epidemiología , Evaluación de Síntomas/métodos
17.
Geriatr Gerontol Int ; 20(7): 709-714, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: covidwho-633890

RESUMEN

BACKGROUND: In December 2019, the outbreak of coronavirus disease 2019 (COVID-19) started in Wuhan, and is now causing a worldwide pandemic. However, the experience in very elderly patients is very limited, which has important implications for the investigation of hospital infection in medical and health institutions. METHODS: Seven patients with confirmed COVID-19 infection in the Department of Geriatrics at Zhongnan Hospital of Wuhan University were included. Clinical data were retrospectively collected and analyzed. Laboratory tests and chest computed tomography (CT) images from the patients before and after the COVID-19 infection were compared. RESULTS: The median age of patients was 91 years old (87-96). Six patients had pneumonia in the last 6 months. Dyspnea occurred in one patient 64 h after the onset of the disease. In the other six patients, minor fatigue with low fever were the only other manifestations of the disease. Lymphopenia and a significant reduction in plasma globulin level was observed compared with levels before the onset of the disease. None had typical chest CT phenotypes during the early stage, except the critically ill patient mentioned who had developed "white lung" and then died. One patient even showed absorption of inflammation compared with previous hypostatic pneumonia. CONCLUSIONS: The ratio of fatal cases in very elderly patients with COVID-19 is no higher than that reported in non-elderly patients was, and probably due to a low immune response. However, the elderly patients manifested minor clinical symptoms and atypical changes in chest CT images, which usually lead to misdiagnosis or delayed diagnosis. Geriatr Gerontol Int 2020; 20: 709-714.


Asunto(s)
Pulmón/diagnóstico por imagen , Anciano de 80 o más Años , Betacoronavirus/aislamiento & purificación , China/epidemiología , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/fisiopatología , Enfermedad Crítica/epidemiología , Errores Diagnósticos/prevención & control , Femenino , Evaluación Geriátrica/métodos , Humanos , Masculino , Mortalidad , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Neumonía Viral/fisiopatología , Evaluación de Síntomas/métodos , Tomografía Computarizada por Rayos X/métodos
18.
Acta Obstet Gynecol Scand ; 99(7): 839-847, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-622517

RESUMEN

INTRODUCTION: The aim of this study is to report our clinical experience in the management of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the first 30 days of the coronavirus disease (COVID-19) pandemic. MATERIAL AND METHODS: We reviewed clinical data from the first 60 pregnant women with COVID-19 whose care was managed at Puerta de Hierro University Hospital, Madrid, Spain from 14 March to 14 April 2020. Demographic data, clinical findings, laboratory test results, imaging findings, treatment received, and outcomes were collected. An analysis of variance (Kruskal-Wallis test) was performed to compare the medians of laboratory parameters. Fisher's exact test was used to evaluate categorical variables. A correspondence analysis was used to explore associations between variables. RESULTS: A total of 60 pregnant women were diagnosed with COVID-19. The most common symptoms were fever and cough (75.5% each) followed by dyspnea (37.8%). Forty-one women (68.6%) required hospital admission (18 because of disease worsening and 23 for delivery) of whom 21 women (35%) underwent pharmacological treatment, including hydroxychloroquine, antivirals, antibiotics, and tocilizumab. No renal or cardiac failures or maternal deaths were reported. Lymphopenia (50%), thrombocytopenia (25%), and elevated C-reactive protein (CRP) (59%) were observed in the early stages of the disease. Median CRP, D-dimer, and the neutrophil/lymphocyte ratio were elevated. High CRP and D-dimer levels were the parameters most frequently associated with severe pneumonia. The neutrophil/lymphocyte ratio was found to be the most sensitive marker for disease improvement (relative risk 6.65; 95% CI 4.1-5.9). During the study period, 18 of the women (78%) delivered vaginally. All newborns tested negative for SARS-CoV-2 and none of them were infected during breastfeeding. No SARS-CoV-2 was detected in placental tissue. CONCLUSIONS: Most of the pregnant women with COVID-19 had a favorable clinical course. However, one-third of them developed pneumonia, of whom 5% presented a critical clinical status. CRP and D-dimer levels positively correlated with severe pneumonia and the neutrophil/lymphocyte ratio decreased as the patients improved clinically. Seventy-eight percent of the women had a vaginal delivery. No vertical or horizontal transmissions were diagnosed in the neonates during labor or breastfeeding.


Asunto(s)
Infecciones por Coronavirus , Parto Obstétrico , Pandemias , Neumonía Viral , Complicaciones Infecciosas del Embarazo , Adulto , Betacoronavirus/aislamiento & purificación , Lactancia Materna/estadística & datos numéricos , Proteína C-Reactiva/análisis , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/fisiopatología , Parto Obstétrico/métodos , Parto Obstétrico/estadística & datos numéricos , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Humanos , Recién Nacido , Pandemias/estadística & datos numéricos , Neumonía Viral/sangre , Neumonía Viral/diagnóstico , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/epidemiología , Neumonía Viral/etiología , Neumonía Viral/fisiopatología , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/fisiopatología , Complicaciones Infecciosas del Embarazo/virología , Resultado del Embarazo , España/epidemiología , Evaluación de Síntomas/métodos , Evaluación de Síntomas/estadística & datos numéricos
19.
Rev Inst Med Trop Sao Paulo ; 62: e44, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-627888

RESUMEN

Coronavirus disease 2019 (COVID-19) is an infectious disease initially reported in China and currently worldwide dispersed caused by a new coronavirus (SARS-CoV-2 or 2019-nCoV) affecting more than seven million people around the world causing more than 400 thousand deaths (on June 8th, 2020). The diagnosis of COVID-19 is based on the clinical and epidemiological history of the patient. However, the gold standard for COVID-19 diagnosis is the viral detection through the amplification of nucleic acids. Although the quantitative Reverse-Transcription Polymerase Chain Reaction (RT-PCR) has been described as the gold standard for diagnosing COVID-19, there are several difficulties involving its use. Here we comment on RT-PCR and describe alternative tests developed for the diagnosis of COVID-19.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Betacoronavirus/genética , Ensayo de Inmunoadsorción Enzimática/métodos , Humanos , Inmunoensayo/métodos , Técnicas para Inmunoenzimas/métodos , Técnicas de Amplificación de Ácido Nucleico/métodos , Técnicas de Amplificación de Ácido Nucleico/normas , Análisis por Matrices de Proteínas/métodos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/métodos , Evaluación de Síntomas/métodos
20.
Rev Mal Respir ; 37(6): 505-510, 2020 Jun.
Artículo en Francés | MEDLINE | ID: covidwho-612987

RESUMEN

The French-language Respiratory Medicine Society (SPLF) proposes a guide for the follow-up of patients who have presented with SARS-CoV-2 pneumonia. The proposals are based on known data from previous epidemics, on acute lesions observed in SARS-CoV-2 patients and on expert opinion. This guide proposes a follow-up based on three categories of patients: (1) patients managed outside hospital for possible or proven SARS-CoV-2 infection, referred by their physician for persistent dyspnoea; (2) patients hospitalized for SARS-CoV-2 pneumonia in a medical unit; (3) patients hospitalized for SARS-CoV-2 pneumonia in an intensive care unit. The subsequent follow-up will have to be adapted to the initial assessment. This guide emphasises the possibility of others causes of dyspnoea (cardiac, thromboembolic, hyperventilation syndrome…). These proposals may evolve over time as more knowledge becomes available.


Asunto(s)
Cuidados Posteriores/métodos , Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Cuidados Posteriores/normas , Atención Ambulatoria/métodos , Atención Ambulatoria/normas , Enfermedades Cardiovasculares/prevención & control , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/rehabilitación , Cuidados Críticos/métodos , Cuidados Críticos/normas , Técnicas de Diagnóstico del Sistema Respiratorio/normas , Manejo de la Enfermedad , Servicios Médicos de Urgencia/métodos , Servicios Médicos de Urgencia/normas , Prioridades en Salud , Hospitalización , Humanos , Pacientes Internos , Pacientes Ambulatorios , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/rehabilitación , Terapia Respiratoria/métodos , Terapia Respiratoria/normas , Evaluación de Síntomas/métodos , Evaluación de Síntomas/normas , Tromboembolia/prevención & control , Trombofilia/tratamiento farmacológico , Trombofilia/etiología
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA